This study of the Russian medical profession examines economic, social and political factors that caused it to evolve differently from medical professions elsewhere. At mid-century most physicians worked for the state in public health-related positions, and had a distinct service orientation. In the ensuing decades they became more independent professionals while retaining a service ethic that they integrated into zemstvo medicine, an innovative program of free rural medical care developed under the aegis of institutions of local self-government. In 1885 the establishment of the first national medical society, the Pirogov Society, encouraged professional consciousness; the Society became a major supporter of zemstvo medicine, grafting its community medicine goals onto physicians' general professional goals. Because of the profession's commitment to zemstvo medicine, when the tsarist regime threatened the zemstvos at the turn of the century, thousands of physicians joined the "zemstvo opposition movement" as a political means to attain their professional goals. This study provides essential background for understanding the later development of Soviet medicine. It is based on materials in U.S. collections of 19th-century Russian medical publications (NLM, LC, Harvard), in libraries in Leningrad and Moscow, and the Central State Historical Archives in Leningrad.